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NPI Code Detail

MEDICARE: BRANDY DEPOORTER PHARMD

MEDICARE: BRANDY DEPOORTER PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist16942NV

General Provider Information

NPI Number : 1356838072
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDY DEPOORTER PHARMD
Provider Business Mailing Address
First Line : 8656 W PATRICK LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-5043
Country : US
Telephone Number : 702-777-7187
Fax Number :
Provider Business Practice Location Address
First Line : 8656 W PATRICK LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-5043
Country : US
Telephone Number : 702-777-7187
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2018
Last Update Date : 04/18/2018

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Directions to “ BRANDY DEPOORTER PHARMD” Practice Location

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